Adulthood Study 1

CS – 50y male, Reactive Attachment Disorder in Adulthood

HISTORY
CS is a 52 year old man, the CEO of a successful local company who sought me out originally for psychotherapy. He had had two encounters with therapy in the past that he had not found particularly useful. He had been diagnosed with bipolar disorder, unipolar depression and adjustment disorder and medication had been suggested. He, however, did not see himself as depressed but as feeling nothing at all. He described his third marriage as a well run partnership in which neither he nor his wife felt anything for the other. He was estranged from his younger son and recognized that he related to his older son coolly at best.

CS comes from a wealthy family of four siblings, of which he is the third. His younger brother was fathered by the mother’s lover and was the only child she professed to love. CS is estranged from all of them. Mother was an alcoholic who was finally hospitalized psychiatrically for several months after CS was grown. During his childhood, it was a common experience for him to find her passed out on the living room floor when he would come home from school. When she was drunk she was abusive and when she was not she was cold and distant. Father was an industrialist who is described as cold, disinterested and easily angered. He disciplined CS with a belt. Father died of cancer at age 59 and it was only during this period of his dying that CS was able to have some meaningful contact with him.

CS had serious asthma by the time he was one year old and was hospitalized with it several weeks every year until adolescence. He does not remember visits from his parents during these stays.

Presenting complaints
“I have no feelings. I don’t love anyone and never have.” ” I see that other people live differently and I think I might like to too.” “I have Barrett’s Esophagus and think that if I don’t change something radically that I’ll die young too.” And somewhat later he said, “Living without feelings is like living without a central nervous system.”

Diagnosis
Reactive attachment disorder. When I explained this diagnosis to him, CS was relieved to finally hear himself accurately reflected.

Problem list
Bruxism, very sensitive teeth, reflux, Barrett’s Esophagus, coldness, anxiety, episodes of anger. Seen as a “prick” by co-workers.

Treatment Progress
CS began his work with me in psychodynamic psychotherapy. He was willing to explore the many difficulties he had in his relationships in his family, in which he was cold and judgmental, and at work where he was seen as a ‘bastard’. The process, however, was clearly painful for him, particularly when he would revisit memories of early childhood and recognize the devastating feelings of motherlessness he felt then and felt still. He was able to cry, which he’d not predicted, but he would always choke off his unbearable grief. Instead he felt hatred for his mother, vitriolic hatred. After several months of therapy we began neurofeedback. TOVA was within normal limits with sustained attention on the low end of normal all four quarters.

Session 1: C4 12-15 for 12 minutes. Feeling only frustration and experienced the beeps as ‘piercing’. Reminiscent of father’s heart monitor. Dropped to 11-14 for 18 minutes. Had come in with a raging headache which was gone by end of session.

Session 2: Reports that he has “preferred to be quiet” since tx. Slept soundly, even through his alarm. This never happened before. After tx had sung Mozart on the drive home. Recognized that he had felt happier and that it was this change in mood that gave rise to the singing. Stride was off when running. C4 at 11-14 for 30 minutes. After tx reports feeling relaxed and lighter. Can “feel pulse in my skin, slow and rhythmic”

Session 3: Reports that it has been hard to move, heavy in mood and body. Not reclusive or sad but low. Quiet and introspective. This lasted two days and then lifted. Slept well. Teeth grinding today but that had stopped for several days. Teeth no longer sensitive to hot and cold. Increased ease in writing, feeling more lucid with words. Remembering better what he reads and increasingly interested in reading. Music is even more moving to him.

C4 at 11.5-14.5 for 30 minutes. “It feels like I have been sitting (meditation).” Very relaxed. Slight headache which remits before he leaves.

Session 4: Logy and lacking energy. Joints ached. Had to take Advil. Effort to talk, all of this better after several days. Does not feel fatigued. Teeth grinding is back. Irritability markedly decreased. General anxiety diminished some. Mood not heavy. Handwriting “more spontaneous, rounder, more open and more artistic” Sleeping 6-7 hours.

C4 at 12-15. Feels relaxed. Pressure in right side of head and right eye.

Session 5: Stumbling over own tongue. Unable to remember words. Stomach has been ‘sour’ for past week. Hard to stay on track. Fitful sleep. Not tired. No body heaviness. Appetite has decreased. No sugar craving. Some trouble reading, sentences do not hold his attention.

C3 at 15-18 for two minutes. C4-P4 for twenty-eight minutes, beginning with 12-15. After 12 minutes he reports feeling detached from things and I go down to 11.5-14.5. He feels this shift “all the way to my spine, which feels very good.”

Session 6: “This is the best I can remember feeling in my life.” “Centered, relaxed all through my body” But reflux is worse and this is of great concern due to Barrett’s. No word problems. Temper feels more even. Sleep is fine.

C3 15-18 for 2 min. C4 11.5-14.5 due to concern that it is the parietal placement that has made reflux worse.

Session 7, 8 and 9: Reports the absence for the first time in his life of anticipatory anxiety [fear]. Sleeping well. Appetite and tastes have changed. No desire for beer. Greater sense of attachment to others “I am actually talking to my wife” A greater interior quiet. Only negative symptom is reflux which he is now having every day. Can’t quite get why this is happening and how to address it until Session 9 when he again reports that in every other way he feels terrific. More relaxed and affectionate. No anxiety at dentist for a visit that would have required valium. “Baseline terror is gone.” But reflux is so bad that he had to try to sleep sitting up.

C3 at 14.5-17.5 for one minute. C4 at 12-15 for 29 minutes. Felt fine immediately after training but within minutes could feel the onset of reflux pain. Went back on and trained at C4-PZ (to the right) at 11-14 for 6 minutes. He could feel things calming down in his stomach.

Session 10: Reflux better than average. Stranger at airport noticed his calm. Verbally very fluid. Bruxism diminished. Jaws not tired. “I am breaking the shell that is around me”

C3 at 14.5-17.5 for one min. C4-PZ at 11-14. Very relaxed.

Session 11: No stomach problems. Reduced stomach meds by half. even with lots of traveling, stress, little control over food. Sexually responsive and generally easier to be with people. Others are commenting on the changes. Relaxed even around strangers. “It is a lot easier to walk the earth” “It is just good to feel clear, alive and unafraid.”

Repeat the same protocol

Sessions 12, 13, 14, and 15: Emotionally much warmer. Feels safe for the first time in his life. Enhanced intuition, “like eating magic mushrooms, it’s that clear”. Everything more vivid. Stomach is great. Everything is great including feedback from family and people at work. When I ask if he loves anyone he says no, that would be going too far. “There is no change in attachment for me” He says that he is acting more attached, that this is not phony but that he is not feeling more attached. He feels gratitude but does not feel moved by it.

This is progress to date. The training has progressed despite many interruptions due to his travel. None the less, CS loves these “marvelous machines.” He is getting along much better with his wife and sons and even with his mother. Able to see that she was “caught in her own psychic pain not staying up nights figuring out ways to decimate” him. He still feels impatient and I have no doubt that he still feels unattached. But even that is changing.

CONTINUATION

This is an update on CS, the man with RAD, whose case in on the web site. He has had twenty more sessions, very episodically and continues to make remarkable progress. I can only wonder how he’d do if we could train regularly. Protocols remain essentially the same with minor adjustments to address reflux and more transient symptoms. Left side training is between 1 and 11/2 minutes.

Session 16: “Something is changing in the Stone Child. There is sun shinning on the stone.”

Session 17: Voice is loud and he describes himself as terribly impatient-not a state he would have seen as dystonic before. Feels he still lacks empathy. After training says, “I will now simply float to the car”.

Session 19: Sleeping well. Stomach is fine. mood is restored. Noticing how much easier it is to sit quietly and do nothing. (This is Mr. Type A, at work by 6 am, after working out, etc.)

Session 20, 21: “I feel almost comfortable in a relationship”. Relationship with wife, the best he’s had. “Words take off without me. Ideas bursting out of my head.” Productive and fluid at work. Co-workers liking him

Session 22: Best time ever with mother. Still feels detached, even when wonderful things are happening. No terror-“I just don’t have it”.

Session 23, 24: BP is 133/80. First time that it’s been that low. Doctor is amazed. Anxiety free but also a deep sense of well-being. “It’s being in another place”. He is changing quickly but still has angry edge, still the shadow of fear in his eyes.

Session 25: Reading faster, retention better. Voice is softer. Feeling more and more aware of how others are feeling. “This”, he said’ “is not entirely easy”. Moved by squirrel hit by a car. had never felt anything like this before. Relationships with both sons are improving-more time and better time.

Session 26, 27, 28, 29, 30: No reflux but allergy attack. “This happens every year” I think it may be training related, and increase left side. Sleep is wonderful. “Amazingly calm” throughout episode of family illness and craziness. Allergies and joint pain remit with increase in left side training. Brother dies unexpectedly, skin rash develops. He sees this as stress related. Steroid treatment.. Reacts very badly to it. Wired. Can’t sleep. Angry and impatient. Even with all the stress, no reflux or stomach pain. It is a month before I see him again.

Session 31, 32, 33: Attempt to address the effects of steroids and rash. I see him infrequently but training seems to help significantly with both problems and he is soon feeling calm.

Session 34: BP 170/101 at annual. Goes back on BP meds. He describes himself as questioning everything and wanting only to find connection and love. “Everything is up for grabs, my marriage, job, house, everything I’ve worked for.” Rash is back. ‘An essential turmoil’.

Session 35: Has left his wife because there was no connection and no love. He can no longer settle for a well run partnership. Forging deep connections with his sons. Thinking and feeling deeply about his brother and the family they both tried to survive. Feeling and managing feelings with more grace. Promoted at work. Well liked. More compassion for his mother.